Changing Health Care Systems and Rheumatic Disease (1996) / Chapter Skim
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12: Conclusions and Recommendations
12: Conclusions and Recommendations
Pages 213-222
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From page 213... ...
As noted in the introduction to this report, the published evidence for differences in treatment received or outcomes achieved by RA and SLE patients in various health care delivery systems is practically nonexistent. The committee was unable to locate any such studies involving SLE.
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From page 214... ...
seek additional funding to expand its research to include substantial support for high-quality studies that would allow a broad approach more closely linking scientific and technological advances to clinical trials, outcomes research, and health services research more generally. Although some of the required research is of the sort currently funded by the Agency for Health Care Policy and Research (AHCPR)
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From page 215... ...
Recommendation: Studies of clinical interventions, health care delivery systems, and clinical course and outcomes should examine clinical, demographic, ethnic, and other subsets of patients with RA and SLE. CONCLUSION 3 Differences in delivery systems may well impact patient satisfaction and the types and intensity of interventions provided to RA and SLE patients, but to date there has been no clear and compelling demonstration of differential impact on the outcome or course of these diseases.
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From page 216... ...
. Recommendations: The incorporation of these clinical and social interventions into different health care delivery systems should be another area of research for NIAMS.
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From page 217... ...
Figure 2 in the paper by Davis and Schoen, for example, shows that patients in managed care systems of all types were more likely to rate their plan fair or poor in providing access to specialists than were unmanaged feefor-service patients. Tarlov's longitudinal data Mom the Medical Outcomes Study highlighted precisely this type of interaction among patients with chronic conditions (some patients had a rheumatic disease, but the study entry criteria specified diabetes, hypertension, congestive heart failure, postacute myocardial infarction, or clinical depression)
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From page 218... ...
Recommendation: NIAMS should encourage research investigating the possibility of increased access to health care plans by persons with RA and SLE where plans opt for, and states allow, such carve-outs. CONCLUSION 8 Checklists and health plan report cards developed for purposes of accreditation or consumer education are useful, but still primitive developments and by their nature are unlikely to provide answers to the questions posed to
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From page 219... ...
Thus, it appears unlikely that report cards on health care plans will provide the type and quantity of data on specific chronic diseases that would allow valid comparisons of individual plans or plan types. Recommendations: Reliable answers to the sort of generic questions posed by NIAMS will continue to require specific research projects using multivariate disease-specif~c measures of the sort listed by Matthew Liang in his reaction to Alvin Tarlov's presentation (the Arthritis Impact Measurement Scales, the Functional Status Index, and the SLE-Disease Activity Index, for example)
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From page 220... ...
A FINAL NOTE · Managed care is a powerful and still growing element of U.S. health care, although it is a heterogeneous movement the final form or forms of which are still evolving.
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From page 221... ...
The interaction of managed care and chronic disease is a complex nexus that requires new research paradigms, which should be as integrative as possible.
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